Catalog Number : cga1992
Title : Addressing Ambiguous Guidance under Medicare
Speaker : Duane Abbey

Webplay Recording Date : 3-15-2017
Webplay Price : $ 150 for two weeks viewing

Webinar Description:

What if we make decisions today that are not correct three or four years from now? How can anyone audit without specific guidelines? To answer these questions and more, come join us in this educational Webinar.

Webinar Objectives:

• discuss ambiguous guidance that is being provided by CMS
• review how ambiguous guidance can affect Medicare audits and recoupment of alleged overpayments
• review the fact that ambiguous guidance shifts the burden of proof to healthcare providers
• discuss the importance of developing written policies and associated procedure to implement policies
• explain the challenges in developing interpretations of CMS guidance that will most likely meet the federal audits
• review the concept of active monitoring for counting observation hours
• discuss the concept of immediate availability for physician/practitioner supervision
• review the current status of related services under the 3-Day Pre-Admission Window
• review the evolving interpretations under the provider-based rule
• discuss possible audit guidelines for meeting the 'Over 2-Midnight Rule'
• recognize the difference between clarifying guidance and changed guidance
• discuss what the over 2-midnight rule really says
• review why the provider-based rule created ambiguous guidance for hospitals and physicians

Target Audience: 

Compliance Officers, Compliance Analysts, RAC Coordinators, Clinical Directors/Managers, Physicians, Practitioners, Nurses, Information Technology Personnel, Computer Analysts, Health Information Management Personnel, Chargemaster Coordinators, Revenue Cycle Specialists, and Internal Auditors

A Few of the Topics that will be covered:

• Ambiguous Guidance From CMS
  • Interpreting CMS Rules, Regulations and other Pronouncements
  • Addressing Ambiguous Guidance
  • The Potential Audit Impact with Ambiguous Guidance
  • Clarifying Guidance versus Changed Guidance
  • Need for Precise Guidance for Appropriate Auditing
  • Shift of Burden of Proof to Hospitals from Precise CMS Rules
• Policy and Procedure Development
  • Policy Issues versus Operational Procedures
  • Conservative Approaches vs. Liberal Approaches
  • Anticipating and Preparing for Future Guidance
• Observation
  • General Issues
  • Developing a Comprehensive Policy and Procedure
  • Interpreting Active Monitoring
• Physician Supervision
  • Documentation Requirements
  • Physician/Practitioner Supervision
  • Operational Issues
• 3-Day Payment Window
  • Related Services Concept
  • Operational Challenges
• Provider-Based Rule
  • Evolving Interpretations and Guidelines
  • Shared Space
  • Under Arrangements
  • Management Contracts
• Over 2-Midnight Rule
  • Inpatient Admission vs. Outpatient Observation
  • QIO Auditing Guidelines
  • Medical Necessity Documentation
• Case Studies

Contact Hours:

• Nursing participants: Instruct-online has approved this program for 1.8 contact hours, Iowa Board of Nursing Approved Provider Number 339

• All other participants: Must attend the entire Webinar and complete a Webinar critique to receive a 1.5 Hour Attendance Certificate for each program.

Full tuition is refunded immediately on request if the participant has not been sent the program materials and instructions. Once the instructions (including access codes) have been sent, a full refund will be issued only after the program runs and it is verified that the participant did not access the program.